Purpose:Little is known about the relationship between resident performance and patient satisfaction. To this end, this institution added housestaff-specific questions to Press-Ganey surveys administered to patients. This study sought to investigate the impact residents have on patient's overall rating of care provided compared with faculty and nursing staff. Methods: Between March 2005 and April 2006, half of all discharged patients randomly received Press-Ganey surveys, including questions on the following categories: admissions, patient room, food, diagnostic testing, guest services, faculty/attending physician, discharge, emotional needs, housestaff, nurse practitioners, and primary nurse. Responses were grouped in overall category scores and used as predictor variables for regression analysis. A separate question asked patients to directly rate overall care provided. Simple and multiple regression models were run using JMP software. Results: During this period, there were 38,206 patient discharges, 19,100 surveys mailed and 4,340 surveys returned (23% response rate vs 26% nationally). In a simple regression analysis, the predictor variables for nursing, housestaff, and faculty accounted for 56%, 34%, and 30% of the variation of overall rating of care delivered (p Ͻ 0.005). The actual overall score for each group varied slightly: faculty (89.7), nursing (86.6), and housestaff (84.8) (p Ͻ 0.005). In a multiple regression analysis, all predictors above were significant (p Ͻ 0.05). A small difference in scores occurred between surgical (83.5) and nonsurgical (84.8) housestaff (p Ͻ 0.05). When data were sorted by surgical services, ratings of surgical housestaff ranged from a high of 87.9 (thoracic) to a low of 79.1 (orthopedics) (p Ͻ 0.05). Admission month had no significant effect on overall rating of care (range, 85-90), although comparing the means of resident scores by month (range, 81-86) showed that at the end (May-June) and at the beginning (July-August) of an academic year, a significant reduction in resident scores occurred (p Ͻ 0.05). The lowest score of the year (81) occurred in June, whereas the highest scores occurred in January-April (85-86). Conclusions: Compared with faculty and residents, nurses have a greater impact on the variation of patient satisfaction. However, the actual scores given to residents, faculty, and nurses are all quite high. A slight difference in scores of surgical and nonsurgical residents was found. For all residents, the time of the academic year impacts positively in the middle and negatively in the beginning and end on resident scores. For surgical residents, clear differences exist between specialty services, but it is not apparent whether these differences are from individual residents or the clinical service milieu. Residents contribute significantly to overall satisfaction, and more investigation of the variation in resident scores is needed.A multidisciplinary systems-based practice learning experience and its impact on surgical residency education.
